We know that for many, wading through explanations of health insurance network plans to pick the right one for you can be daunting.
We will walk you through the various types of plans ‒ HMO, PPO, POS, and EPO, but before we do that, we need to go through some terms.
Here are few terms you need to know:
This is the amount you will pay each month to be covered by your chosen insurance plan.
Many plans require you to pay an amount of the cost of service before insurance pays the remainder. The amount you must pay is the deductible.
Copay is the basic fee you pay for each incident of care, such as a $20 fee for each visit to a doctor’s office. Co-insurance is a percentage of the total charges you pay for a medical cost; for example, you may be required to pay 20% of the total costs of a doctor’s
A Health Maintenance Organization allows you to see any doctor in the plan’s network or list of doctors. If your primary care doctor refers you to a specialist, that care covered. If you need emergency care at a facility not in your network, the facility must charge you what your plan would charge for similar care. However, doctors at that out-of-network facility may bill.] you.
A benefit to this plan is that you have little or no paperwork.
Under a Preferred Provider Organization you get some ability to choose your doctors and you do not need a referral to see a specialist. If you choose a doctor outside the network, you may have to pay a balance after insurance. There is little or no paperwork if you see a network doctor.
A Point of Service plan combines features of the two above plans, but gives more choice for you to select providers. You can see your doctor and any referred doctors. If you see a doctor out of the plan, you must pay the bill and then fill paperwork for reimbursement.
Under an Exclusive Provider Organization you have some freedom to choose your health care providers and you do not need referral for a specialist. If you seek treatment outside of your network list, you must pay full cost. There is little or no paperwork.